To Pharmacist: For Eligible Patients: Process a Coordination of Benefits (COB/split bill) claim using the patient’s prescription insurance for the
PRIMARY claim. Submit a SECONDARY claim to PDM under BIN: 610020. Commercially insured patients will pay as little as $0 with an annual
maximum limit of $10,000. The secondary claim will cover up to $10,000 patients’ out-of-pocket expenses per year. Depending on insurance
plan, patients could have additional financial responsibility for any amounts over Eisai’s maximum liability. Patient is not eligible if patient is
enrolled in a state or federal healthcare program, including Medicare, Medicaid, Medigap, VA, DoD, or TRICARE and where prohibited by law.
This offer is for commercially insured patients only. By submitting this card, you are certifying that the patient is eligible and you have not
submitted and will not submit a claim for reimbursement under any state or federal healthcare program for this prescription. For questions,
please call 1-855-EISAI-4-U(1-855-347-2448).
Terms and Conditions: Good toward the purchase of LENVIMA prescriptions. The LENVIMA Co-pay Program provides up to a maximum of
$10,000 per year to assist with the out-of-pocket costs for LENVIMA. Depending on the insurance plan, a patient could have additional financial
responsibility for any amounts over Eisai’s maximum liability. No substitutions permitted. Not available to patients enrolled in state or federal
healthcare programs, including Medicare, Medicaid, Medigap, VA, DoD, or TRICARE. Offer only available to patients with private, commercial
insurance. Not valid for LENVIMA prescriptions reimbursed in full by any third-party payer. Save this information for reuse with each
prescription. May not be combined with any other discount offer. Program is not valid for cash paying customers. Federal law prohibits the
selling, purchasing, trading, or counterfeiting of this card. Void outside the USA and where prohibited by law. Eisai Inc. reserves the right to
rescind, revoke, or amend this offer at any time without notice. You must be 18 years or older to use this card for yourself or a minor. Patients
and pharmacies are responsible for disclosing to insurance carriers the redemption and value of the program and complying with any other
conditions imposed by insurance carriers, third-party payers, and applicable law on the redemption. The value of this program is not contingent
on any prior or future purchases. This card may not be accepted at all pharmacies. This card is not an insurance program. No membership fees.